Reflections: Letter to My 18 year Old Self

Have you ever wondered what you could have done differently if you can turn back time? As I’m going to start another new phase of my life soon, I thought it would be appropriate do a self-reflection post for the past 10 years. Honestly, I have always wanted to try write one of these ‘advice to my younger self’ letters.

Me at 18

I know it’s a fact that I have changed and grown in many ways. What I valued at 18 and my perspective of life is really different now. After graduating, I realized I have kept myself a prisoner in a cocoon for far too long and wished I could have challenged myself a little more.

At 18, I was still in the carefree stage of life and the reality of the future has not hit me yet.  I hope by sharing this letter it will help to give some value to those who are aspiring to become dentists.

So here it goes – a letter to RC at sweet 18

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Hey Rei Chiel,

It's me, you from 10 years later. As I recall, you must have just left college and about to spend 9 months idle before you start dental school.  These 9 months are very precious time which you can invest to grow your general knowledge and they are I-M-P-O-R-T-A-N-T. Spend more time reading and read far and wide. Take heed of your mother’s nagging to be interested in world issues, economics and business. She meant it well and you will thank her for it because from where I am now, I regret not knowing much more.

Ever since young you have been obsess of becoming a dentist and quite determined at least finishing your tertiary education till a postgraduate level in orthodontics.  However, I know you ACTUALLY don’t really know what you are diving into. Dentistry has many dimensions and if you plan it right, can turn out to be a rewarding career. You not only need to be a good clinician but also learn how to be an entrepreneur (which you will learn nothing of this in dental school).  There are so many roles to juggled which makes this field interesting but yet daunting at the same time.  It would be good if you seek out of opportunities to shadow a dentist before you go off to India. Don't be fooled by those cliché quotes in line with "Follow your passion and you will never work a day in your life" Life is more dynamic than that and passion can change over time. You won’t always be happy as a dentist. There will be days you will drag your feet to work and have to face stresses you did not even think about before. The work you are about to do is very tedious and precise. You will have to manage patients (human beings) of different temperaments and limiting anatomy (e.g.: small month openings, macroglossia, hypersalivation). You will also have to work with unmotivated staffs and having to juggle between being nice or strict with them. You will face many things that are beyond your control but don’t let all these weighs you down. Just aim to be better than yesterday and encourage those around to do the same.

This is a life long journey of learning. It is a fact that you will not be well equipped to handle every case when you first join the workforce. There will be times you aren’t the most confident and when things don’t go as planned for example you broke a root tip and unable to retrieve it, you will feel like a failure. You may even lose sleep thinking about your patients. IS OK REI CHIEL. There will be hiccups and please don’t beat yourself too much. Rather than allowing introspection overtake your mind, take steps to improve and relearn. One key thing while at university, don’t be scare to make lots of mistakes while you have the lecturers to hold your hands. Playing it safe while in dental school will only be at your disadvantage in the future when you have to work alone. Build your experience and mistakes can be your best learning tool. Those who were fighting for the chance to learn aren’t inconsiderate of others; they see the value in experiencing it first hand in order to help others next time.

Keeping yourself spiritually and mentally fit is also important. Daily, you may meet patients that come in and tell you they hate being here, they were traumatized in the past, they dread the sound of drill, demanding for a discount or even asking you the entire spectrum of dentistry. It can get quite toxic and drains your energy. It is crucial you identify with these frustrations and struggles. Pour them out with your close friends and don’t bottle up. Rely on God’s word to draw strength and encouragement. In time of extreme anxieties, run to the Lord in prayer. Also, do not develop the habit of comparing yourself to others. With the bloom of social media (For you, I guess it is still the era of MSN messenger or is it Facebook messenger?) many people will start to look for validation through these platforms. You will see how your friends (especially those who aren’t dentist) are doing well: enjoying their work and living life to the fullest. You will feel like you are so constricted in the clinic premise 6 days a week, not progressing much in your work or life. Don’t compare yourself with others! What they do with their life is none of your business and you shouldn't measure yourself against them. Behind the scene, people are striving for what they want. Remember you are not trying aim for the worldly successes (power, riches, fame) but living your life serving God and your neighbors. Learn to count your blessing everyday and give thanks.

Also, try to shed off your shyness. You will have lots of opportunities in the future to meet with great people and many a time you lose out because you don't dare to initiate the conversations. Listening to other is good, but you got to also learn to form your own opinion about things and not be the silent listener. Be more vocal, thick-face and be interested in others.

I know you are very idealistic that this stage of life and is having a rosy picture of the future. You are not fickle minded about your decisions and want to strive for your goals. You like to know that you have everything planned out and what’s coming next. However, I hope you do realize that life is an unpredictable journey. There is no such thing as a perfect life. The next 10 years WILL BE a roller-coaster ride but you will also be surrounded with many good Samaritans by your side. It is you that need to stay humble but yet bold. Be curious and seize the moment. Don’t be disappointed if things don’t turn out the way you wanted because in every disappointment comes an opportunity to experience something different. That is more valuable and helps to shape you into a better person. Live like today’s your last and strive for the best to help others in need.

I love you,

Your 28 years old self

25th MDA SCATE 2018 @ PWTC & Dr Ashwin's Rubberdamology @ The Dental Academy

Group A mini reunion @ Nau's 

(This is so overdue)

I’m not going to apologized AGAIN for not updating as frequently as I used to in the past. Not that I was busy, it was more of laziness and the lack of motivation to write. These days I noticed I have somehow developed a pessimistic outlook in my clinical judgement and execution, often expecting the worst outcome. The dental graduate that used to be so optimistic and confident in her work has overtime wither away. Sometimes I questioned why did I chose this field previously. I still in the midst of sorting out this confusion within me.

Ok, enough rant on my emotion rollercoaster, this blog entrée is about the events I attended earlier this year.

MDA SCATE Jan 2018
(WhatsApp msg)

Finally on some magnification!

Rach

Jom Pergi Conference MDA? - Syasya 

I replied “Ok”. And hence I paid a few hundred ringgits to renew my MDA membership and signed up for the conference.

“Going to conference again? Why you dentists always have to attend so many conferences?” asked my mum.

I pretty much looked forward to SCATE ever since joining the private sector. Coop up in the clinics 6 days a week doing intricate meticulous work and meeting the demands of patients can lead to isolation and professional burnt out.  For me, dental conference is not only one of the means for continuous professional development but also a good opportunity to take a break from the clinic. It is where active learning for dentist happens post-graduation. There will be brewing conversation about the trends and advances in dentistry, exchanging clinical experiences and ideas, trying the latest gizmos and getting a good discount to restock clinical supplies. Some also view this as a good opportunity reunite with friends and batchmates.

Photo credits: Syasya

There are two major annual dental conferences held by the MDA; SCATE in the beginning of the year and MIDEC around mid-year. As compared to MIDEC, I noticed that the lecture topics in SCATE usually are tailored for the junior dentists.

There were two to three lecture sessions lined up every hour. We had to choose between the mundane and the remarkable. I took interest in the full mouth rehab presentations. I was amazed and humbled by the treatment plans and clinical work presented. One good take home message was advances like the Digital Smile Design and Chairside CEREC technology still rely on basics taught in prostho, cons and perio. Fundamentals are still important. Besides that, I found the lecture on Managing Dentinal hypersentivity most useful. The sensitive toothpastes in the market all contains different active ingredients and its effectiveness may varies for each individual. Patient should be encourage to try out different sensitive toothpaste to find the one that works the best for them and stick to that particular one.

I wasn’t only attending lectures but also went around scouting for materials and instrument I needed in the trade exhibition. The exhibition hall was filled with set up booths, some with tall kiosks with banners advertising cool new instruments, appliances and materials that you had never heard of with impressive multimedia presentations. And of course drs are not oblivious to the ‘bribery’ each booth has to offer. It’s common to see lines forming while drs giving away their personal contact info in exchanged for the latest merchandise (often toothbrushes and toothpaste). You can hear some murmur that this year givings weren’t as good as previous year. Others were simply handing out souvenirs (like an innocent pen or tote bags) stenciled with their brand logos together with paper brochures or catalogues. I felt somehow the exhibition hall was strategically placed as we have to navigate ourselves to dining area through the maze of sales booth. Probably they hope that on your way to teatime or lunch your attention will get caught with the big fancy ads or by a smooth tongue salesperson. Some companies prepared hands on kiosk for the drs to try out the various products. Also, some booth had a crowd swarming around a projection screen with a man dressed in suit and headset microphone giving a short lecture and demo.

As Joe and I were strolling down each alley, we were lucky enough to stumbled upon a supplier who was giving a demo on BioLase laser. We signed up for the hands-on session on the second day. Together with 3 other drs, we were introduced to a transparent glass high tech looking device in front of us. The sales rep gave a 10 mins PowerPoint presentation and have us all put on the yellow bug eye looking safety googles before the demo. Next thing we know, we were happily carbonizing away tomatoes and sausages. Gingivectomy would have been such a straight forward procedure instead of using traditional blade. One of the participating dr had a traumatic ulcer and offered for us to use the laser on him. We were lucky enough witness the effects of the laser on a real traumatic ulcer without any LA and the results were instant. All 5 of us were sold that afternoon. 

By the third day the meeting rooms were no more than half filled and the crowd was inside the exhibition hall instead of the lecture halls. You could sense the enthusiasms for actual learning have tapered down. Among those attendees, a large chunk either dozed off or left early to stroll the trade show. For me, I left the conference early to get some rest before the start of another new week.

Dr Ashwin's Rubberdamology Feb 2018

A few weeks after SCATE, I was lucky enough to book a spot for Dr Ashwin’s Rubberdamology hands on session @ The Dental Academy. We all know that the usage of rubber dam is the gold standard for isolation for any restorative work but many just brush off the idea in the name of inconvenience. Those who are reluctant often claimed that patient disliked it and it takes too much effort and time to isolate a tooth for just a simple filling. Personally, I find that the dam actually gave me a piece of mind to work especially in the lower posterior regions. Instantly, you do not need to worry about the cheeks, tongue and the pooling saliva. It makes clinical dentistry more awarding and stress-free.

I had a bad experience back in final year of dental school when I had to place a dam on a 12 y/o patient with the lingual wall of tooth 36 at equigingival level. The clamp kept popping out and the interdental gingiva were so traumatized. I put off the idea of using the dam after that. Ever since then, the last time I ever placed a rubber dam was on the typodont model during our final exams. However, I always wanted to be comfortable in placing the dam on patients and this course really gave me that confidence.  The confusions on to use wing or wingless clamps; heavy or medium dam sheets; to dam first, clamp first or the dam and clamp together technique were answered. According to Dr Ashwin, is best to give Local Anaesthesia prior to placing the rubber dam as it can ensure a comfortable experience for you and your patients. Also, you would not be able to clamp the tooth if significant buccal or lingual wall is missing so build up that wall first before placing the dam. He also showed some crown cases done with Vertical Tooth Prep and introduced the Thermacut bur used in DME cases; both were new concepts to me. We all were also given a set of his famous rubber dam clamps kit to bring home. I think by far that was the best hands on course I ever attended and those who are struggling with the dam should really sign up if there is a next one. 

ps: 

A miracle happened!
(Will write a post on my experience of the exam later) 

Kapit, MES Conference, and Updates of My Life in Sarikei

Finally got my ID card!

This is my first post in 2017 and quarter of the year has gone by. I still have intentions to continue blogging but just that I have busy with work and hardly have the mood to write. One of my friend asked me if my blog is already dead and that spurred me to finish up this draft that’s been sitting on my desktop for months. So, this is an update on my life.

Somewhere in October, my parents came over for a visit. We did a day trip to Kapit, a town that is only accessible by boat up the mighty Sg. Rajang. The boat ride took 3 hours and Jewel, the nyonya was waiting for us by the jetty when we arrived. I was attracted to the mural painting of Orang Utans brushing their teeth just across the jetty. We only managed to spent a couple of hours roaming the small busy town before catching our return boat ride back to Sibu. The boat services start daily from 5:45 am till 3:30pm if I remembered correctly. They only operate when there is daylight to avoid stirring the boat into logs floating in the river. The biggest attraction Kapit got to offer is their huge busy central market. Many villagers from the interior come and sell their goods in the market and therefore you can get a huge variety of things from there especially exotic animal meat and wild fruits or vegetables. As they say you reap what you sow, you eat what you catch. I saw fresh water fishes in bright yellow, civet cat, wild boar head three time the size of my head. I think you will need a pretty big pot to cook that head! On the contrary, the Chinese community there are mostly Hokkiens and not Foo Chow like in Sibu or Sarikei. Before heading back to Sibu, we stumbled upon an old vintage Tukang Gigi shop. He was out that day and we only managed to speak with his daughter in law who operates the other half of the shop selling stationary. She told us he is currently in his eighties and still making dentures for occasional customers who seek for his service. I wanted to get to know him, know his stories, how he shipped that heavy cast iron dental chair to Kapit and maybe in the future I can buy over his vintage dental posters once he retires for good.

1st class seats with powerful aircon blasting at us for 3 hours. They were screening Tarzan on the TV. 

Crossing the speedboats carefully or else into Sg. Rajang I go

My favourite mural painting

Roasted Civet Cat anyone?

Small and compact town

Getting your haircut done beneath the staircase is an in thing okay! 

The Tukang Gigi Shop

Sam in Kapit too

Kapit's Busy Jetty

Last November I joined the Malaysian Endodontic Society Annual Conference for the second time! I was super excited the week before, looking forward to drench in some Endo lectures. I pulled along Phyllis, my fresh graduated junior to join me. There was noticeably less junior dentist this round compared to the year before.  Here are some highlights I picked up in the conference. 

From Dr. Jaruma Sakdee who concentrated on Dental Trauma from endo perspective: Don’t promise anything for trauma case! Keep calm and expect the unexpected. Every case will be unique. She also highlighted that genetics can play a role in the body response and prognosis. Far too often, patient will seek for some sort of guarantee from their clinicians but it’s crucial not to be overconfident. The ‘under promise, over deliver’ rule applies and we can at most cited the percentage found in evidence base and reassure the patient that you will try your best for their sake.

From Dr. Mike Gordan: He brought to light the expectation for the road ahead as a dental specialist, there will be more observation in clinical cases, you will begin to find out what work and what don’t work as day by day new material and instruments are being introduce in the market. He did stir my interest to find out more on CBCT artifacts and that sometimes we shouldn’t just blindly rely on technology for our diagnosis. As he pointed out using the Scintillating Grid Illusion, you can’t always believe what your eyes are telling you.

I also like this slide of his below which reveal the opinion of different discipline of dentist handling the case scenario presented.

What do you see from the radiograph? 

Dr Marino Sutedjo also presented on controversies in endo (ninja vs sumo access opening; disinfection vs. medication; endo as a focal infection causing illness?) with evidence based point of view to keep us intact and sound of why we are doing what we are doing in endo field.

Other concepts like Minimal Invasive Endodontics and 25.04 prep were relatively new approaches I took home with me from the conference lectures. I was also fortunate to join a quick 15 minutes hands-on using the Wave One Gold file and the GuttaCore on an acrylic block. I was also glad to pick up the composite polishing disc kit that I was looking for so long from the trade booth.

 

Met Dr Vikram. To the right, Phyllis.

December month had been pretty happening for me. I went to Kuching twice over the span of one week and took the Christmas week off for a family trip in Harbin China! My clinic organized a study tour to some of the dental clinics in Kuching and I tagged along.  For those who know me well know that I was really hoping to get a posting in Kuching but the Lord had other plans for me. I’m not going to complain but Sarikei has been pleasant so far. The Sarikeians are easygoing type of patients, fairly easier to handle than the demanding urbanites of the bigger cities. My patients are mostly Ibans and Foo Chow Chinese so I’m practically conversing daily in Malay and Mandarin. Sometimes I have to mix up my Malay with some Bahasa Sarawak or Iban to get an effective communication with my patient. This year I hope to travel and visit places towards the north of Sarawak: Mukah, Dalat, Bintulu and the Barrio Highlands.

 

Sg. Sarawak

Damai Beach with our not-sexy-back

Study tour at KP PetraJaya

Compulsory Photo with Santa Cat of Kuching though Phang and I were soaked in drizzling rainwater

Town mice talking photo with beautiful Christmas Tree infront of the Spring

I just like the store name

Sibu's Vintage Cinema

Entering the working world also brought much self-realization for me. From time to time, I find that I am lacking in this aspect and that skills, failing to be the ideal clinician I wish I am. I try to grow myself by reading up articles, to keep up the new techniques and materials in the world. It is like I’m chasing after a fast-moving bullet train, and am I limited by my time, finances and energy.  Currently I’m into my 4^th week of Hospital Specialty Posting. The past 7 months in primer care I have been involved in providing basic dental treatment in the local government dental clinic as well as involved in school dental project for a month. 

My School Dental Clinic Setting

Treatment Needed 

Giving a talk at the school hall

Definitely, there are advantages and disadvantages of working in the government set up. Sometimes I feel frustrated and wasted; so many things could have been done than worrying over paperwork and statistical returns. There is unending emphasis over quantity over quality. As compared to my peers working at other parts of Sarawak, I do get leeway to perform many things that aren’t allow elsewhere (as a first-year dental officer) and I am grateful for that. Having said that, many a times I do get upset that I couldn’t provide a total holistic care for my patient. It might be due to time, lack of resources or manpower. I will still strive hard to provide the best for them within my capabilities. Also, I’ve been observing around me the manifestation of human natural and how sometimes it is your convenience that matter over patient’s well-being. Whatever happen to oral health awareness and prevention strategies. And being in that environment daily one can easily get influence and conform to that common practice if you don’t stand back and reflect daily.  

 

Rain clouds rolling over Sarikei Town 

And in come the flood

That’s all from me this time. Bu-bye~ 

Ps: Following a collection of farewells photos from the past few months. 

My permanent officers leaving for the pennisular

The last goodbye

Birthday celebration at our usual dinner place

Before heading home for Chinese New Year

Farewell to our senior FYDOs

PPS: Forgot to share that I passed my MJDF Part 1. Hip-hip-hooray!

Hopefully I will get similar result for Part 2. God willling~ 

Sarikei? Where is that?

Bhai forced me to try this Snap Chat filter

Good day fellow readers! It’s been almost three months since I came to the land of the hornbills.  Sorry for my long hiatus from this page. I was busy settling down in Pineapple Town of Sarawak. After taking a year of involuntary holiday, I finally have reached the light at the end of the tunnel.

The moment when I got the result of my placement, I was thrown into a mix of emotions. I was terrified and excited at the same time. It was my choice to apply here. I have opted for this road less taken, wanting full autonomy of my future destiny; I did not want any surprises from MOH. My mother told me I was crazy and naïve, not knowing what unpleasant experience might lies ahead. Many others also look upon me with sympathetic eyes whenever I answer them I choose to work here. They did not know I wanted to challenge myself, to see whether I will be able to handle what life have to offer me in a foreign land. All in all, I reminded myself, God have His will for me there and He will guide me along the way. Have faith and go.  

We started off our first day as government servants by attending Program Transformasi Minda (Program Transforming Minds) for 5 days and 4 nights at Kolej Sains Kesihatan Bersekutu Sultan Azlan Shah, Ulu Kinta.  A total of 106 new dental officers were appointed during my intake. The purpose of PTM was to introduce new staffs to the principles and work culture of the government sector.  We started every day by singing out national anthem and MOH corporate song (Kami Sedia Membantu). We sat through four full days of lectures on the function of various government agencies and policies. Besides that, we were divided into 7 groups and required to complete two group tasks. The first task was to draw a kampong setting while answering a related question. The second task was to present a sketch based on a given scenario. I enjoyed the group activities as it allowed us to interact with people from other colleges, exchanging stories of their undergraduate life and find those who will be reporting at the same state as you. By the end of the fifth day, we sat for a MCQ test before leaving to our respective place to report for duty.  

 

Registration chaos 

One of the many lectures

Batik-fie

Half-past-six drawing

A scene from my group's sketch

Kumpulan 5

A photo before we separate (Miss this bunch of people)

The place we slept for that 4 nights

That Sunday after PTM, I flew into Kuching and Bong hosted me for that night. It happened that the Kuching Food Fest was on so she and her mom brought me to try the food stalls there. Early next morning I booked a taxi for half a day to JKN to report duty. The taxi driver was a retired policeman and he filled me with stories of his dangerous experience guarding the coast of Sabah from pirate as we made our way to Petra Jaya. A total of 9 new DO were send to Sarawak. Most of us arrived by 7:30 am and we were usher by a sister into the meeting room; all of us anxiously awaiting to be told the place we will call home for the next one year. As I look across the unfamiliar face around the table, I felt a sense of loneliness as I was the only one among my batchmates who got posted here. After what seems like forever, we were greeted by Dr. Shirley Hu, the person in-charge of FYDO placement. We went around the table with a brief self- introduction before she read out our district (called Bahagian in Sarawak) placement. My name was the last off the list and I was praying so hard to get Kuching. However, the Lord’s Will is that I go to a small town called Sarikei. I was actually shocked of my placement. I remembered Bharavi jokingly asked me during PTM “What if you get Sarikei huh?”

Solo travel begins now

Bound for Cat Land

My mind was disoriented and unable to accept this arrangement. I wanted to run away from reality, like how Jonah attempted to escape when God ask him to go to Nineveh. Knowing that I would regret if I did not put up a fight, I tried to ask for a possibility to change to Miri but I was shot down by Dr Shirley “If you are prepared to do voluntary work (do not receive salary), I can let you come to work in Kuching or Miri.” – That was like a slap across my face.

 

Map of Sarikei if you are interested to know

That time reality sank in and I look across to the faces of my new colleague who receive the same fate as I, all wearing that confused dejected faces. The next instant, all 4 of us were relentlessly searching for flight tickets with our phones. My mind was fill with questions of why God want to send me to Sarikei, envying the 5 others who got placement in either Kuching or Miri. Once we were all dismissed, 4 of us who got placement in Sarikei came together to discuss how we would travel to our new work place. Three of us agreed to take the last flight by MasWings that night. On the way, back to Bong’s house, I tried to keep the conversation with the taxi driver going, trying not to think about my utter disappointment in my placement posting, almost at the brink of tears. After booking my flight, I actually planned to skip lunch and sleep off the negative feeling but Bong and her mom encouraged me to have lunch and took me out. I felt much better after food. That evening, Bong brought me to the airport after her work and we had dinner at Secret Recipe. She jokingly told me that this might be the last chance to have proper Western food before flying off to an unknown land with two new friends, Aileen (from Sibu) and Ling (from Kuching). Two of them have the most interesting personality and I thought to myself, maybe it won’t be that lonely in Sarikei after all. Our flight got delayed by an hour and we arrived at Sibu around 11 pm. Ling and I bunked into Aileen’s in law house for the night. It was really awkward to sleep over at a newly made friend in law’s house and more so to share the same queen size bed with her. Truly that was really God’s hands moving in the most secret way.

 

MasWing for the first time

Early next morning, we travelled down to Sarikei. The journey took about an hour from Sibu. They first dropped off Ling’s and my luggage at Hotel 808 before going to Klinik Pergigian Sarikei. Since our District Dental Officer was on leave on that day, we were told to straight report duty to our DOIC. After a quick briefing, we were taken downstairs by Sister to complete our medical checkup. We were required to redo our urine test for drug clearance and have a Chest radiograph done. We were given the afternoon off to find a place to rent and settle down.

I solely relied on Aileen’s and Ling’s contact to find a place to rent as Sarikei is a small town, rarely people advertise their properties online. After visiting 10 or more places for the three days, suddenly we came across a minimally furnished double story terraced house which Aileen and I couldn’t resist. After 3 days of staying over at a hotel, I finally found a place to stay for the year.

 

Moving in!

My FYDOship consists of 8 months Primary care in KP Sarikei followed by 4 months Oral Surgery posting in Klinik Pakar Hospital Sarikei. Our DOIC asked us to observe the seniors and the clinic system flow for the first week before taking up cases. Also, it took around two weeks to complete all our paperwork.

 

Never knew the existence of the Blue passport till recently

My unit, nampak kemas oh!

Currently am happy with the exposure I am getting in this place, still trying to gain back the lost confidence. As a new DO, I am still not use to making the decision for patient treatment plan, sometimes running to my seniors for a confirmation. I guess with time I will be more independent.

 

One day, my senior decided to do a candid camera on me. 

Entering a new place without knowing anyone and trying to settle down can be difficult and taxing. I think I can now relate why no one from the west wants to serve here. I can relate what home sick feels like. I can relate what being trap in feels like.  But God have been good to me, surrounding me with helpful and supportive people. I am grateful for the friends and colleague I have met. Sarikei would have been that much gloomier and lonely without them.

 

Celebrating 25th Birthday with the lovely colleagues

You can count on her for the most random questions ever

I trust that every cloud has a silver lining and God will continue to lead the way, you just need to trust and obey. 

Sarikei, why you so hot?!